Justices: Pharmacists must tell of risks

Pharmacists have a legal duty to warn patients or contact their doctors when they are aware of a specific health risk to a patient, the Nevada Supreme Court ruled Wednesday.

The court's decision came in a case that involved an elderly woman who died after taking a sulfa-based medication that "chemically cooked" her body when she suffered an allergic reaction noted in her patient profile.

In a unanimous ruling written by Justice Ron Parraguirre, the court reversed a lower court ruling in a wrongful death suit filed against Walgreens by the family of 86-year-old Helen Klasch.

"We conclude that when a pharmacist has knowledge of customer-specific risk with respect to a prescribed medication, the pharmacist has a duty to exercise reasonable care in warning the customer or notifying the prescribing doctor of the risk," the court said.

Khahn Pham, a Las Vegas-based pharmacist and representative of the Nevada Pharmacists Association, said it is best practice among pharmacists - and common practice among the pharmacists she knows - to contact the doctor whenever any flags are raised about allergies. In her experience, she said, every doctor she's raised an issue with has gone with an alternative medication.

"When you are not sure (about an allergy), then you double check because you could put the patient's life at risk," said Pham, who had been following the case in the lower courts.

Ensuring a patient's safety isn't just a legal issue, Pham said, but is a moral issue.

"It's unfortunate that (the issue) had to go to the Supreme Court ... but it is already in the pharmacists oath - there is no small issue when you could put a patient's life at risk."

Klasch died in 2006 after taking a sulfa-based medication prescribed by Dr. Frederick Tanenggee to treat her for a urinary tract infection. Her patient medical history noted a possible allergy to sulfa.

According to court documents, the doctor said her infection could be treated most effectively with a Bactrim, a sulfa-based antibiotic, and asked Klasch to clarify how certain she was of her allergy.

Klasch downplayed the note in her medical history and asked for the prescription, which she took to Walgreens. A separate settlement was reached in a suit filed against Tanenggee.

When Klasch's caregiver picked it up, a pharmacy employee told her the prescription had been "flagged" by the computer system because Klasch's patient profile also noted her sulfa allergy.

An employee then called Klasch, who said she had taken Bactrim in the past and had no adverse reactions. The pharmacist then overrode the computer system's warning and filled the prescription with a generic form of the drug, according to court records.

Later that day, Klasch complained of feeling "itchy." She was taken to the emergency room the next day where she was diagnosed with Stevens-Johnson Syndrome/toxic epidermal necrosis - a reaction that causes "blistering of the mucous membranes ... and patchy areas of rash, followed by the entire top layer of skin ... peeling off in sheets from large areas of the body," according to expert testimony in the case.

Klasch was taken to the burn unit at University Medical Center, where she lapsed into a coma and died with burns covering 40 percent to 50 percent of her body, court documents said.

"In lay terms, Helen's skin was chemically cooked off of her body from the inside," her lawyers wrote in appeal documents.

Walgreens argued that under existing legal doctrine, the pharmacist fulfilled her duty filling Klasch's prescription with the correct medication and dosage. The "learned-intermediary doctrine" is designed to prevent pharmacists from interfering with doctor-patient relationships by second-guessing physicians.

Clark County District Court Judge Michelle Leavitt granted summary judgment in favor of Walgreens, ruling that the pharmacist's duty is limited to filling the prescription as written by a doctor unless there is "plain error" or the prescription is "obviously fatal."

But the high court said that while pharmacists have no duty to warn of prescribed medication's generalized risks, the doctrine "does not foreclose a pharmacist's potential for liability when the pharmacist has knowledge of a customer-specific risk."

Justices reversed Leavitt's action and sent the case back to the lower court for further proceedings.

Nevada Appeal business reporter Nick Coltrain contributed to this report.